New Critical Care Facility Enhances Treatment for Seriously Ill Patients

According to Neil A. Halpern, Chief of the Critical Care Medicine (CCM) Service and Director of the ICU, approximately 55 patients are admitted to the ICU each month, with an average length of stay of 6.5 days. The unit cares for both medical and surgical patients. Around 20 percent of these patients come through the Urgent Care Center, Memorial Sloan-Kettering's equivalent of an emergency room, 17 percent directly from surgery, and the remainder from the hospital medical and surgical floors. Almost 80 percent of patients admitted to the ICU are able to leave the unit and resume treatment.

The CCM Service has five full-time and two part-time attending physicians who are all certified in critical care medicine and represent diverse areas such as internal and pulmonary medicine and anesthesiology. They lead a team that includes nurses, critical care fellows, anesthesiology and medical residents, nurse practitioners, respiratory therapists, dialysis technicians, pharmacists, and administrative staff.

This multidisciplinary team now works out of a new, state-of-the-art unit on the 11th floor of Memorial Hospital. The 20-bed ICU -- which opened in April 2007 and replaced the former 12-bed unit -- uses sophisticated equipment and innovations in design and layout that are changing the way care is delivered to Memorial Sloan-Kettering's most seriously ill patients. "We wanted to build a facility that would provide a more healing atmosphere for patients and their families, but that at the same time employed the latest technological advances both in the marketplace and in critical care medicine," Dr. Halpern said.

New Intensive Care Unit Memorial Sloan-Kettering's State-of-the-art facility opens slide show

In 2004, planning began for a significantly expanded ICU with room for additional beds. Dr. Halpern convened a design team that included representatives from a variety of hospital constituencies, including physicians, nurses, architects, facilities design and construction, nutrition, pharmacy, information management, hospital administrators, and experts in infection control and security.

"The top priorities in designing the new unit were more space for staff to take care of patients, more privacy for patients, more comfortable conditions for patients' families, and improved infection control," Dr. Halpern said.

The new 18,000-square-foot facility -- compared with the 4,000 square feet of the previous unit -- presented an opportunity to streamline the delivery of care to patients. "We wanted to bring the instruments of monitoring, treatment, and care closer to the bedside and reduce the need for nurses to leave the patient and go back and forth between the bed and the nurses' station or pharmacy," Dr. Halpern explained.

In the new ICU, nurses are now able to spend more time in close proximity to their patients, each of whom occupies his or her own 300-square-foot room. Just outside each patient room is a workspace where nurses can perform functions that formerly were carried out at a nurses' station. A window between the workspace and the room allows nurses and patients to remain within sight of one another, helping to ease patients' anxieties and enabling nurses to observe their patients while they work.

Also located near the entrance of every patient room are cabinets that can be opened from both the corridor outside and within the room. Accessible only to authorized staff, they permit the stocking of medications and supplies without supply aides having to enter the room, thus reducing the risk of infectious transmission and preserving patient privacy and tranquility.

In an area for medical and nursing staff within each patient room, two computer screens allow doctors and nurses to pull up information about a patient without leaving the bedside. Each room is also equipped with its own laboratory label machine and bar code scanner so staff can label specimens taken from a patient while the samples are still in the room, greatly reducing the chances that a specimen will be mislabeled.

Ceiling-mounted jointed columns, better known as "booms," house many of the essentials for patient care -- such as patient monitors, oxygen, air, suction, power, network jacks, a nurse call button, and telephone -- without taking up valuable wall or floor space. The booms move easily to where they are needed, so beds no longer have to be against the wall as they do when connections from a stationary headboard supply these necessities. Additionally, the booms allow the patient beds to be rotated in any direction. If physicians or nurses need access to a patient for a particular procedure, the bed can be turned to accommodate it, or to allow space for devices such as ventilators, dialysis machines, or ultrasound devices that may need to be brought into the room.

Many other design features add to the ICU's overall functionality. The unit's layout contributes to ease of staff movement, with multiple cross corridors. Pneumatic tube stations at both ends of the ICU provide direct connections to laboratory facilities. A satellite pharmacy in the unit dispenses medications. And a dialysis suite with two dedicated treatment rooms is also available.

The ICU has wireless network and infrared (IR) connectivity. All staff members wear two-way wireless communicators so that they can converse instantly with any member of the ICU team working in the unit or elsewhere in the hospital. Staff and mobile equipment such as the defibrillators, pulse oximeters (which measure oxygen levels in a patient's blood), dialysis machines, and ventilators have IR or radio-frequency identification tags that signal their location to the nursing stations or to Web-based systems.

Patient rooms are equipped with Web cameras capable of panning in all directions. These allow physicians and staff to observe patients from locations other than the ICU. "The resolution is high, and allows you to zoom in if you want to see how tubes and catheters are placed, or to look at the monitor on the boom to read the patient's vital signs," explained Stephen M. Pastores, Director of the Critical Care Fellowship and Research Programs. "In conference, if we are discussing a patient, it helps a great deal if we can pull up the Webcam to observe him or her." In fact, information from all bedside monitors and ventilators can also be accessed through Web-based systems.

Infection control is vitally important in the ICU due to the often-weakened immune systems of cancer patients. In the new unit, a patient is protected by sliding glass doors at the room entrance. Taking advantage of new technology to ensure patient privacy, these doors and the windows between the rooms are glazed with liquid crystal display glass (often called "e-glass"), which realigns crystals to prevent passage of light when an electronic current passes through it. This glass, which replaces the traditional curtains that accumulate germs, changes from transparent to opaque at the flick of a switch.

Multiple sinks and hand sanitizers, both within patient rooms and throughout the ICU, reduce the risk of infection from staff or visitors. In addition, the floor of the entire unit is made of a rubberized material that is seamless and easy to clean -- as well as being shock absorbent for the benefit of the medical staff who spend many hours on their feet.

	Critical Care Medicine's Stephen Pastores and Neil Halpern

The ICU was designed to foster as tranquil an atmosphere as possible for patients and families. The patient rooms and hallways feel open, outdoor light pours in through the many windows, and the nature-themed artwork lends a sense of calm. Patient rooms have views of Manhattan or the East River, and their walls are insulated with sound-retardant material that muffles noise. The rooms include comfortable seating for visitors, wireless Internet access, a flat screen TV, and a DVD player.

"Some patients will bring in a DVD of their families, which they can watch right in the room, helping to keep them relaxed," said Marie-Helene Lofland, Nurse Leader, Intensive Care Unit and Hemodialysis.

Families can also pass the time in a large waiting area down the hall from the ICU. The space features frosted glass partitions so that each family has a semiprivate sitting area. The waiting room also includes vending machines, flat screen televisions, computers with Internet access, a consultation room where families can speak privately with doctors, and a social worker's office.

"When you care for critically ill patients, you're not only taking care of the patient, you're also addressing the needs of his or her family members," Ms. Lofland observed. "They're often emotionally upset and need support. Sometimes, we communicate more with families than with patients, who may be under sedation."

The new critical care facility also offers conveniences for staff and creates an improved environment for instruction and training. The ICU has a well-appointed suite for on-call doctors and a general staff lounge with large windows that provide sweeping views of the city.

Early in 2008, new facilities for the CCM attending and administrative staff, and the CCM fellowship and nurse practitioner programs and Respiratory Care opened down the hall from the ICU. This area includes offices for the CCM physicians, work areas for respiratory therapists, and multimedia conference and simulation training rooms. All told, the new ICU and critical care facilities constitute 26,000 square feet of space, compared with 7,000 for the previous ICU and staff offices.

"Having everything on the same floor is a great advantage in bringing care faster and more efficiently when staff members are called to the bedside," Dr. Pastores said.

Looking ahead, many of the ICU innovations will help advance the care of critically ill patients in the future -- by providing a superior learning experience for those training in the fellowship program. "The setup of the new ICU, with all its technology, modernization, and creative design, allows our trainees to experience cutting-edge medicine," Dr. Pastores said. "We consider the education and training of our fellows to be a vital part of our mission. They are the next generation of leaders in critical care medicine, here at the Center and elsewhere."